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TUBE FEEDING AT HOME: A GUIDE FOR FAMILIES AND CAREGIVERS

CW.01.07 Published Date: 12-Oct-2018 of 1 Review Date: 12-Oct-2021

This is a controlled document for BCCH& BCW internal use. Refer to online version. Print copy may not be current. See Disclaimer at the end of the document.

Document Owner:

C&W Nutrition Committee

Purpose of Document(s):

This is a reference tool used for educating families and caregivers regarding tube feeding at home.

This manual was last updated in 2003. In current state, the manual is outdated but not unsafe. This revision included: update logos, removal of references to resources that no longer exist (e.g., Special Products Distribution Centre), spelling corrections.

A broad scale revision will occur in 2019 under C&W Nutrition Committee guidance.

Applicability

BC Children’s and BC Women’s Hospital + Health Centre

Version History DATE DOCUMENT NUMBER and TITLE ACTION TAKEN

3-Oct-2018 CW.01.07 Tube Feeding At Home: A Guide For Families And Caregivers

Approved at: BCCH Best Practice Committee

Disclaimer This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part as per the Terms of Use on the website.

A Guide for Families

and Caregivers

May 2003

BC Children’s Hospital and BC Women’s Hospital and Health Centre

Tube Feeding at Home - A Guide for Families and Caregivers May 2003 Page i

Fourth Edition, 2003

The practices of nutrition support are continually evolving with new

knowledge and guidelines from expert authorities. This booklet is being published with the aim of providing guidelines for tube feeding that are

consistent with the most recent scientific data. Where research is not available, the practice guidelines are the best as derived from the collective experience of the health professionals at BC Children’s Hospital,

and BC Women’s Hospital and Health Centre.

The development of these guidelines involved thorough and repeated

review by health professionals at Children’s and Women’s Health Centre in the fields of neonatology, pediatrics, nursing, infectious disease, nutrition and public health. The input of these professions has been invaluable and

we are most grateful for their assistance.

The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any injury resulting from any material

contained herein. This booklet contains information relating to general principles of medical care and should not be construed as specific

instructions for individual patients. Product information and package inserts provided by the manufacturer should be reviewed for current information including contraindications, dosages and precautions.

This booklet was developed and printed with the support of the Sunny Hill Hospital Auxiliary.

All parts of this publication may be reproduced, stored in a retrieval

system or transmitted in any forum by any means – electronic, mechanical, photocopying, recording or otherwise – without requesting the prior permission of the Nutrition Committee, Children’s and Women’s

Health Centre.

Dr. Sheila Innis, Chair Nutrition Committee Children’s and Women’s Health Centre

of BC


Tube Feeding at Home - A Guide for Families and Caregivers May 2003 Page ii

Table of Contents

Introduction: What is Tube Feeding? ................................................... 1

The Digestive System ....................................................................... 2

Gastrostomy and Jejunostomy Tubes .................................................. 3

Information about your child’s feeding tube ......................................... 4

Gastrostomy Tubes: G-Tubes ............................................................. 5

Low Profile Gastrostomy Devices ........................................................ 6

Jejunostomy Tubes: J-Tubes .............................................................. 8

Caring for the Stoma and Feeding Tube ............................................. 10

Checking the Stoma and Feeding Tube .............................................. 12

Cleaning the Stoma and Feeding Tube ............................................ 133

Caring For The Mouth ...................................................................... 14

Oral Stimulation During Tube Feeding ............................................... 15

Transition From Tube To Oral Feeds .................................................. 16

Tube Feeding Schedules: Intermittent and Continuous ........................ 17

Tube Feeding Formula ..................................................................... 18

Information about your child’s tube feeding supplies ........................... 19

Tube Feeding Schedule: Intermittent (Bolus) Feeding ......................... 20

Tube Feeding Schedule: Continuous or Overnight Feedings ................ 222

Giving Tube Feedings ...................................................................... 23

Formula Hang Times ....................................................................... 27


Tube Feeding at Home - A Guide for Families and Caregivers May 2003 Page iii

Giving Medications through a Feeding Tube ....................................... 31

Preventing and Solving Problems (Alphabetical Order) ........................ 34

Telephone Numbers ........................................................................ 50

Appendix A: Monitoring Progress ...................................................... 52

Appendix B: Ongoing Questions & Concerns ....................................... 54

Appendix C: List of Terms ................................................................ 55

Appendix D: Additional Resources for Families & Caregivers ................ 57

Appendix E: Reinserting a Gastrostomy Tube (G-Tube) ....................... 58

Appendix F: Reinserting a Jejunostomy Tube (J-Tube) ........................ 60

References ............................................................................ 61


Tube Feeding at Home - A Guide for Families and Caregivers May 2003 Page iv

Figures Table of Contents

Figure Title Page

1 The Digestive System ................................................... 2

2 Placement of Feeding Tube ........................................... 3

3 PEG –Tube with Port .................................................... 5

4

5

Placement of Feeding Tube ……………………………………………..

Bard Button……………………………………………………………….

5

6

6 MIC-Key Skin Level Device ............................................ 7

7 J Tube ........................................................................ 8

8 Radiologically-Placed Tube ............................................ 9

9 G-J-Tube .................................................................... 9

10 Foley Gastrostomy Tube .............................................. 58

BC Children’s Hospital, and BC Women’s Hospital and Health Centre

Tube Feeding at Home - A Guide for Families and Caregivers September 2018 Page 1

Introduction: What is Tube Feeding?

Tube feeding is a way of giving liquid food (often formula) directly into the stomach or small bowel.

This formula provides the body with the nutrients needed for good health. Tube feeding can be used for children who:

Cannot eat at all

Do not feel hungry

Need extra nutrition – higher amounts of protein and calories Cannot eat or drink enough regular food or fluids because they tire

easily or cannot chew or swallow well.

Right now, you might feel quite overwhelmed by the idea of tube

feeding at home. Please know that we will teach you what you need to know before you go home with your child. You will also be able to

practice your new skills before going home. Please ask any questions or discuss any of your concerns with us. There is no such thing as a silly question!

The information in this booklet will help you to carry out tube feeding at home. Please feel free to write notes or questions in it. It might

also be helpful if you bring this booklet to your appointments.

Please discuss any questions

or concerns with us.



The Digestive System

Figure 1: The Digestive System



Gastrostomy and Jejunostomy Tubes

There are many different types of tubes used. The tube chosen

depends on the needs of the child. All of the tubes are soft with rounded tips on the end that is inside the body. There are one or

more openings, called “ports”, on the other end of the tube that is outside of the body. These openings or “ports” are used to connect

the feeding bag.

A gastrostomy (G-tube) or jejunostomy tube (J-tube) is a small soft tube that goes into the body through an opening in the abdomen

and ends inside the stomach (G-tube) or small bowel (J-tube). The liquid food (formula) goes through this tube into the stomach or small

bowel.

Figure 2: Placement of Feeding Tube



Information about your child’s feeding tube

1 Tube type and brand:

2 Tube size:

3 Health Care Provider that inserted the tube:

4 Date the tube was inserted:

5 Date when tube should be changed:

6 Where to go to have the tube changed and who can change it:

7 Other details:

Write your child’s

information here.

Keep this page for

your records.



Gastrostomy Tubes: G-Tubes G-tubes are placed into the stomach and come out through the skin of the abdomen. They may be held in place by sutures, an inflated balloon, by

internal/external bumpers or by a disc.

Here are some examples of different types of G-Tubes:

PEG Tube (Percutaneous Endoscopic Gastrostomy) This is a silicone tube inserted by a surgeon or gastroenterologist in a hospital. It is

inserted under general anesthesia or sedation. A surgeon or gastroenterologist will change the tube as needed.

Different types of tubes.

The tube chosen depends on your

child’s needs.

Figure 3: PEG with Port

Figure 4: Placement of

Feeding Tube



Gastrostomy Balloon Type Tubes

Initially, a surgeon or gastroenterologist puts in these tubes. Gastrostomy tubes last from 6 weeks to 6 months depending on the tube. A nurse or skilled caregiver

in the home or hospital can change them.

Low Profile Gastrostomy Devices

These are small, flexible silicone rubber devices that can be put in surgically or can be used to replace the original gastrostomy tube (described above). They are called “low profile” because they are

small and at skin level. They can be held in place by an internal bumper or balloon.

Here are some examples of different types of gastrostomy

devices:

Bard Button A Bard Button is most often inserted into an established stoma. It can last for about 12 months.

Figure 5: Bard Button



Gastrostomy devices continued...

MIC-KEY Is inserted surgically or inserted into an established stoma and lasts about 4 – 6 months. These tubes can be changed at home.

Figure 6: Mic-Key



Jejunostomy Tubes: J-Tubes

Here are some examples of different types of J-Tubes:

Surgical Jejunostomy Tube (J-Tube)

A surgical jejunostomy is a tube that is placed into part of the small

bowel (jejunum) by a surgeon. This tube will last about 1 – 2 years.

Radiologically-Placed Jejunostomy Tube through an established

Stoma

Under local anesthetic, this tube is inserted by a radiologist in the hospital. It is changed every 3 – 6 months.

Figure 7: J-Tube



J - tubes continued...

Radiologically-Placed Gastrostomy -

Jejunostomy (G-J) Tubes A radiologist in a hospital inserts these tubes.

They are inserted under anesthesia. These tubes are usually changed every 3 – 6 months

by a radiologist.

Figure 9: G-J Tube

Figure 8: Radiologically Placed Tube

COMBINED TUBE:

Gastrostomy-Jejunostomy Tube (G-J Tube)

A G-J tube is a tube that is put through the stomach via the gastrostomy into the

jejunum. It is inserted by a radiologist and is replaced every 3 - 6 months.



Caring for the Stoma and Feeding Tube GENERAL INFORMATION:

The stoma is a surgically created opening on the skin where the feeding tube enters the body.

Always keep the skin around the stoma and under the

bumper/disc/button as clean and dry as you can. The skin disc or bumper on the outside of the tube should be approximately

½ inch (about the width of a dime) away from the skin.

Do not apply creams or dressings to the stoma unless your

nurse or primary health care doctor has suggested this. Most skin irritations heal quickly when left open to the air. Creams

and dressings stop the air from reaching the stoma.

Always make sure that the feeding tube is in the correct position before starting a tube feeding or giving medication. To check the position of a gastrostomy tube, gently pull back on

the tube to make sure it is against the stomach wall and then measure the length of the feeding tube that is outside of the

body (see page 4 for the length that it should be).

Wait at least 7 days after new the tube is inserted before swimming or bathing. When you go swimming, tape the tube securely to your child’s stomach using a waterproof tape.

Participation in sport activities is fine once the stoma is no

longer tender. If there is a hit to the abdomen, there may be some pain but it is usually not an emergency unless the pain is

intense or the pain does not get better. It is best to have the tube checked by a primary health care doctor or nurse if the pain is intense or does not get better or if there is any bleeding

or bruising around the child’s stoma site.

Children can lie in any position that is comfortable. It is best to try and prevent babies and other children from pulling or playing

with the tube. You can cover the tube with an undershirt or sleeper. Try to keep the stoma and tubing outside of the diaper to keep it clean.

Before you care for the stoma or tube - wash your hands! Washing your hands can prevent the spread of illness! Washing your hands is one of the most important steps you can take when

caring for your child’s tube feed.

The BASICS.

Remember

washing your hands is one of the

most important steps you can take

when caring for your child’s tube

feed.



When washing your hands please make sure you:

Remove rings and watch. These can trap germs.

Use warm water and regular soap and rub all parts of your hands and wrists. Friction is the best way to get rid of harmful germs.

Wash for 30 seconds. Hint: Sing “Happy Birthday to You” (the whole song) and

30 seconds will have passed.

Rinse well. Leave the taps running and dry your hands with

a clean towel.

Turn off the taps with the towel.



Checking the Stoma and Feeding Tube

GENERAL INFORMATION:

With every feed, check the following things:

A. The Skin – Problems to watch for:

Skin redness greater than 1/2 inch (1 to 2 centimeters)

around the tube

Tenderness, discomfort or pain around the tube

Discharge (leakage) from the stoma.

Swollen skin

Bad smell

If you see any of these, go to pages 43 & 44 to find out what to do.

B. The Tube:

Check the feeding tube for any leaks or cracks.

If it is cracked or leaking, go to pages 40 & 41 to find out what to do.

Measure the length (position) from the stoma to the end of the tube. Write this number down. Compare the measurement to the measurement you made when the tube

was first inserted.

If it is shorter than it should be, the tube may have moved into the stomach (see page 4). Gently pull on the tube until the internal bumper balloon is snug against the stomach wall. Then measure again to

make sure it is the right length.

If it is longer in length, the tube may be coming out. DO NOT USE the feeding tube. Call the nurse or primary health care doctor.



Cleaning the Stoma and Feeding Tube GENERAL INFORMATION:

Keeping the skin clean and dry helps avoid skin irritation and

breakdown. Usually you will clean the stoma and tube twice (2 times) each day. Using a clean wash cloth or cotton ball, wash the skin around the tube with mild soap and water. Also clean the skin

anytime there is leakage around the tube.

HOW TO CLEAN THE STOMA AND FEEDING TUBE (The nurse will check which steps should be followed):

Prepare and clean work area, and wash your hands! Washing your hands can prevent the spread of illness!

Washing your hands is one of the most important steps you can take when caring for your child’s tube feed.

Gather the equipment:

Clean wash cloth Cotton balls

Cotton tip swab (Q-tip) Mild Soap

Warm water Other: ______________________

Wash your hands again before touching the equipment and patient/child. Gently lift the sides of the disc or tube to reach all

areas of the skin. Do not pull hard on the tube. This can hurt the inside of the stomach or intestine.

Use a cotton swab or Q-tip to gently clean under the disc or around the tube.

Clean the outside of the tube with soap and water.

Rinse the skin with warm water. Pat the skin well with a soft towel or leave open to air.

Seven days after having a gastrostomy tube surgically inserted,

your child can soak in a bath tub or go into a swimming pool. The

tube and stoma can be easily cleaned in the bath tub.



If you use tape to keep the tube in place, do not tape over the

same patch of skin each time as this can irritate the skin. When you tape the tube, loop the tube loosely and tape it to the skin.

Wash your hands once again after you are all finished.

Caring for the Mouth

Brush your child’s teeth at least twice a day. If the child is able, he or she can do it.

Rinse your child’s mouth with water, mouthwash, oral swab (such as a Toothette1) or cloth frequently throughout the day.

Put a lip moisturizer on the lips to keep them moist.

To help make saliva flow and keep the mouth clean and moist, a Toothette1, Gum Stimulator set, hand or a soother may be used.

1 Toothettes should not be used with children who have a strong bite reflex.



Oral Stimulation During Tube Feeding For children who cannot eat or drink by mouth, tube feeding

does not mean the end of pleasures associated with eating. Some children are able to take small amounts of food. It is easier to increase oral feeding than to completely

restart it. Oral-motor stimulation can be nutritive (with tastes) or non-nutritive. Your doctor can tell you which is

best for your child. Including an oral-motor stimulation program at daily mealtimes will help create a positive approach.

Extended periods of tube feeding can contribute to reduced

oral-motor skills. Unpleasant procedures and experiences may result in oral aversion (hypersensitivity and defensiveness around the face and mouth).

General Principles of Oral-Motor Stimulation 1. It should be fun and enjoyable for child and caregiver.

2. Incorporate into regular play times and during tube feeds. 3. If child does not tolerate or becomes stressed, stop and try

again later at a level of stimulation that s/he likes and slowly work at progressing stimulation.

PLEASE USE THE FOLLOWING AS A GUIDE TO HELP YOUR

CHILD:

Non-nutritive Oral-Motor Stimulation 1. Pleasant touch around mouth area i.e. Cotton balls, terry

cloth, soft toothbrush, soft toys.

2. Explore shapes and textures i.e. teething toys, own hands, nipples, spoon, especially shapes that your child will

eventually use for feeding. 3. Firm but gentle massage on the upper body & face. 4. During tube feeding times, encourage your infant to suck

on a pre-pumped breast or soother.

Nutritive Oral-Motor Stimulation 1. Offer tastes of a variety of suitable foods/liquids. Some

children enjoy strong flavors.

2. Dip soother, infant spoon or teething ring into milk or purees for child to taste.

3. Rub lips and gums with small amounts of food/liquid then place some centrally on tongue to encourage sucking or tasting.

Sensory stimulation is

also an important part

of a tube feeding.



Transition From Tube To Oral Feeds GENERAL INFORMATION:

It is very important that the child who is going to be moving from only having tube feedings to oral feeds learn how to eat

safely. The transition from feeding a child through a tube to oral feeding is a process that usually requires planning and

support.

First, an experienced occupational therapist and/or speech-

language pathologist should assess a child’s eating and swallowing skills.

Once a child is starting to eat, a nurse and/or dietitian will

provide support to ensure that the process is going smoothly.

This is a very individual process and needs careful assessment and planning. If an occupational therapist or

speech-language pathologist does not follow your child, request a referral from the primary health care doctor before

starting to feed your child by mouth. READINESS FACTORS TO CONSIDER PRIOR TO MAKING THE

TRANSITION FROM TUBE TO ORAL FEEDING:

1. The medical conditions(s) that resulted in tube feeding should be resolved or stabilized.

2. Can your child eat safely and in a reasonable length of time?

Indications of an unsafe swallow may include: Inability to handle saliva/secretions

Noisy, wet sounding breathing Multiple swallows to clear food Frequent unexplained respiratory illnesses

Coughing/choking while eating or drinking Changes in their breathing while eating or drinking

E.g. Stops breathing, change in oxygen saturation or color 3. Nutritional readiness

Can your child tolerate intermittent feeds?

Is there sufficient weight gain to tolerate a possible small loss while transitioning?

4. Behavioral readiness Is your child showing hunger cues? Is your child showing an interest in food?

5. Social factors Caregiver would need motivation, skills, time and support for

successful transition from tube to oral feeding

This is a very individual

process and needs careful assessment

and planning.



Tube Feeding Schedules: Intermittent and Continuous There are different types of feeding schedules used. Your schedule will

depend on the child’s nutritional needs as well as life style.

When the feeding tube is first put in, it is common

for tube feedings to begin as a slower continuous

feed to help the body get used to the formula then

move to an intermittent feeding schedule.

Intermittent Feedings

Intermittent feedings, sometimes called bolus feedings, are

tube feedings given over short periods of time several times throughout the day. These feedings can be given

by a pump or by gravity.

The timing of the tube feedings can be changed to allow 2 – 3

hours between the end of one feed and the start of the next feed to allow time for the stomach to empty. Intermittent

feedings resemble the normal pattern of eating and digestion.

Continuous Tube Feedings

Continuous feedings are given at a steady rate, for as many hours as needed, over a 24-hour period to

provide the energy and nutrition required. A pump will be used to control the steady rate of these tube feedings.

A feeding into the jejunum tube is usually given at a slow continuous rate because, unlike the stomach, the small bowel is

not able to hold large amounts of formula. In certain situations a feeding into the stomach may also be given as a continuous

feed.

Combined Intermittent (bolus) and Continuous Tube Feedings

In some situations bolus tube feeds are given during the day

and continuous tube feeds at night.

Different types of feeding schedules.

The feeding

schedule chosen depends on your

child’s nutritional needs as well as

lifestyle.



Tube Feeding Formula

There are more than 80 types of formula products available. The dietitian will discuss with you the best type of formula for your child.

Infants (0 - 12 months) An infant under a year of age will usually receive

expressed breast milk and/or infant formula for the tube feeding.

Children (1 – 10 years old) A child will usually receive a pediatric formula that is made to meet the specific

nutrient needs of this age group.

Older children (over 10 years of age) and adults

Both the older child and adult will usually receive a formula that is made to meet the specific needs of this

age group.

Depending on the situation, the dietitian may

recommend adding vitamins and/or minerals to the formula as needed.

The dietitian will discuss

with you what the best type of formula for your child is.



Information about your child’s tube feeding supplies

1. Tube feeding formula:

2. Alternate formula:

3. The brand, type and size of feeding bag and tubing to use:

4. Type of adaptor

5. Syringes

6. Replacement feeding tube:

7. Foley Catheter Size #_________ (in case tube falls out)

8. If used, the brand of the pump:

9. The formula and feeding bags can be obtained from:

At Home Program

Home Enteral Nutrition Program

Medical Supply Companies such as: _________________________________

10. Other details:

Supplies can be purchased from local pharmacies.


information here.

Keep this page for

your records.



Tube Feeding Schedule: Intermittent (Bolus) Feeding

Date: Name:

1. Formula: Size: (mL) = containers/cans

Formula: Size: (mL) = containers/cans

Formula provides: Kcalories grams of protein/day mL of free fluid/day

2. Number of tube feedings each day:

3. Amount of formula at each feeding: (see Feeding Schedule next page)

4. Amount of water flush before each feeding: (use syringe to flush tube)

5. Amount of water flush after each feeding: (use syringe to flush tube)

6. Give each feeding over: minutes/hours or at the rate of:

7. Goal for weight: pounds kilograms

8. Weigh and record your child’s weight every: days (see Appendix A: page 52)

9. Other pertinent information:

Phone the healthcare provider if you have any questions about this schedule. This includes questions about the amount of formula, feeding times, and weight gain,

etc. Contact Name: ___________________ Phone : _________________________


information here.

Keep this page for your records.


Tube Feeding at Home - A Guide for Families and Caregivers May 2003 Page 21

Tube Feed Schedule

Time of Day

Formula &

Amount

Water added

to feeding bag

Water flush

before and after

feeding

Medications

Water before and

after medications



Tube Feeding Schedule: Continuous or Overnight Feedings

Date: Name:

1. Formula: Size: (mL) = containers/cans

Formula: Size: (mL) = containers/cans

Formula provides: Kcalories grams of protein/day mL of free fluid/day

2. Start time(s) of tube feeding:

3. End time(s) of tube feeding:

4. Give each feeding over: minutes/hours or at the rate of:

5. Flush feeding tube with: mL of water every: hours (use syringe to flush tube)

6. Wash and rinse the tube feeding bag every four (4) hours throughout the day and night or use an alternate set of bag and tubing. See page 27 for complete instructions.

7. Goal for weight: pounds kilograms

8. Weigh and record your child’s weight every: days (see Appendix A: page 52)

9. Other pertinent information:

Phone the healthcare provider if you have any questions about this schedule. This includes questions about the amount of formula, feeding times, and problems with weight gain, etc.

Contact Name: ______________________ Phone : _____________________________


information here.

Keep this page for your records.


Tube Feeding At Home - A Guide for Families and Caregivers May 2003 Page 23

Giving Tube Feedings GENERAL INFORMATION:

Wash your hands! Washing your hands can prevent the

spread of illness! Washing your hands is one of the most important steps you can take when caring for your child’s

tube feed.

When washing your hands please make sure

you:

Remove rings and watch. These can trap germs.

Use warm water and regular soap and rub all

parts of your hands and wrists. Friction is the best way to get rid of harmful germs.

Wash for 30 seconds. Hint: Sing “Happy Birthday to You” (the whole song) and 30 seconds will have passed.

Rinse well. Leave the taps running and dry your hands with a clean towel.

Turn off the taps with the towel.

Store unopened containers of formula in a dry place at room temperature. Check the expiry date stamped on the container and do not use formula after the expiry date.

Store opened containers of formula in the refrigerator.

Cover the top of the container and label it with the date and the time it was opened. Storing formula in the refrigerator

will help to reduce bacterial growth that can cause illness.

Throw out unused formula in opened containers after

24 hours.

Throw out any formula that has been open or hanging in a tube feeding bag at room temperature for more than the

recommended hang time (See table on page 27).

Rinse and wash the bag and tubing, see page 28 for instructions on how to do clean up. Equipment that is not

carefully cleaned may contaminate the formula and cause illness.



If possible, the child should be sitting upright in a chair or

wheelchair at the table during the feeding and for at least 30 minutes after the feed has finished.

If feeds are given in bed, make sure that the head of the bed

is elevated 30 degrees during the feed and for at least 30 minutes after the feed has finished.

Flush the feeding tube with water before and after each bolus feeding and when giving medications to prevent a

blocked tube. If the child is 3 months or younger, flush with sterile water.

Experience has shown that flushing the feeding tube with water every four (4) hours during a continuous tube feeding

will help to prevent a blocked tube. If the child is 3 months or younger, flush with sterile water.

Do not add fresh formula to formula that is already hanging

in the bag.

If using a pump, refer to the instruction booklet given

on how to use the pump.



GETTING READY:

Step 1 Prepare a clean work area and wash your hands.

Step 2 Gather the equipment:

Feeding bag and tube Tube feeding formula

30 – 60 cc Syringe Lukewarm water or sterile

water if the child is less than 3

months old If needed, a feeding adaptor or connector for

low profile devices. IV pole, coat rack or hook/nail in the wall A pump, if using

Other: ______________________

Step 3 Wash your hands again before touching the equipment

and patient/child. Check the stoma for any leaking, skin irritation, infection or swelling. If you notice any problems, refer to pages 43-46.

Step 4 Measure the feeding tube that is outside of the body

and compare it to the length measured before, see page 4. If it is shorter, gently pull on it until it is the right length. If it is longer, DO NOT USE the tube for

feeding. Call the nurse or primary health care doctor.

Step 5 If you are reusing a feeding bag, check that it is clean and does not have any leaks. If the bag smells sour, is cloudy, has a different colour or just looks dirty,

throw it away and use a new bag and tubing.

Step 6 Rinse the top of the formula container with water and wipe dry. Shake the container well.

Step 7 Open the container(s) of formula.

If the container of formula has been in the

refrigerator, allow it to stand at room

temperature for 15 – 20 minutes before using or warm in a warm water bath. If the formula

is too cold, it may cause cramping.



DO NOT USE the microwave to heat the formula because this breaks down the proteins.

Step 8 Close the clamp on the feeding bag tubing. If using extension tubing, add it to the bottom of the feeding bag tubing.

Step 9 Fill the feeding bag with enough formula to be used within the recommended hang time. Refrigerate unused formula in a clean covered plastic or glass

container or covered can. Mark the date and time the container was opened. After 24 hours, throw

out any opened formula that has not been used.

Step 10 To prime the tubing (some infusion pumps will prime the tubing for you): open the clamp and

allow the formula to fill the tubing. Do not fill the drip chamber more than ½ full.

Step 11 When the formula reaches the end of the tube tip,

close the clamp. Ask you health care provider how to plan for continuous feeds if that is the schedule that is

recommended for feeding your child. (If using some of the pumps, this is not necessary. Refer to the pump instructions).

Step 12 Using an IV pole, coat rack, hook or nail in the wall, hang the feeding bag about 18 inches (46 cm) above the stomach.



Formula Hang Times

Type of formula If re-using

bags and tubing If not re-using

bags and tubing

Ready to Serve Formulas

Maximum 4 hours Maximum 8 hours

Formulas prepared from powder or

concentrate


Formula with additives


Fresh Expressed Breast Milk


Previously Frozen Expressed Breast Milk




MEAL TIME:

Step 1 The child should be in a comfortable, upright position

in a chair or wheelchair. If this is not possible, the child can lie down on a bed with the head of the bed or crib elevated 30 – 45 degrees. With infants, cradling

while holding the baby upright in your arms for feeding may work best.

Step 2 Draw up _____ mL of lukewarm water into the

syringe. Check to see that the feeding tube is clear by flushing it with _____ mL of lukewarm water. If the

water does not go in, refer to page 35.

Step 3 Connect the feeding bag tubing to the adaptor, if used, and then to the feeding tube.

Step 4 Open the clamp on the feeding bag tubing to allow a steady drip. Suggested rate: _____. If a pump is being used, refer to the instructions on

how to use the pump.

FINISHING UP:

Step 1 After the formula has finished, close the clamp on the

feeding bag tubing and disconnect it from the feeding tube.

Step 2 Using the syringe, draw up _____ mL of lukewarm

water. Use sterile water if your child is less than 3 months of age. Flush the feeding tube. Close the clamp on the feeding tube.

Step 3 First, rinse the feeding bag and tubing with cool clean water. Then, wash the feeding bag and tubing (and adaptor or connector if used) with hot soapy water. Use a

bottlebrush to get the corners of the bag to remove old formula and prevent bacterial growth. Rinse well with hot

water.



Step 4 Shake really well to remove excess water from the feeding

set. The goal is to remove as much water as possible from the inside of the bag. Wrap the feeding set in a

clean, dry towel and store it in the refrigerator. Storing the bag and tubing refrigerated will help reduce bacterial growth.

Step 5 After the last feeding of the day, wash and rinse the feeding bag and tubing as described in Step 3 and Step 4. Many families find it convenient to alternate using 2

sets of feeding bags and tubing. While one is being cleaned the other one is ready for use.

You must clean the feeding bag and set AT LEAST once a day.

Step 6 With good cleaning feeding bags and tubing may be

changed twice a week.

Never use the bag if it smells sour or is cloudy or “looks dirty”.

If a pump is used, the feeding set tubing may stretch over time and will not infuse the formula at the

desired rate. If this happens, replace the bag and tubing set.

Note Well: Current recommendations from the manufacturers

state that the feeding set is to be changed everyday.

By keeping this equipment extremely clean, it is both practical

and economical to change supplies less frequently. Keeping the

supplies clean prevents bacterial growth which can cause

serious illness. Ask your health care provider for more

information.



FEEDING ADAPTORS:

Low profile feeding adaptors and connectors are usually changed every 4 weeks.

Wash adaptors and connectors in the same way as a feeding bag and tubing is cleaned.

SYRINGES:

At least once a day take syringes apart (separate the barrel

and from the plunger) and cleaned in warm, soapy water. Rinse well with hot water.

Allow syringes to air-dry on a clean surface between uses.

Change syringes twice a week.

Syringes are changed twice

a week.



Giving Medications through a Feeding Tube


The tube may be used to give medications. However if the

child is able to take medications by mouth, use this route.

Not all medications can be safely given with a feeding tube. Check with the primary health care doctor or nurse. If

possible, give medications by mouth.

Do not mix medications with the formula.

NEVER mix other medications with antacids or vitamin

supplements containing iron, calcium or magnesium.

Give each medication separately with water flushes between

each medication.

Give medications as directed by the primary health care doctor or pharmacist.

Use liquid medications when possible to avoid blocking the feeding tube.

Dilute thick liquid medications such as Phenytoin, Docusate,

Lactulose or certain antibiotics with 5 – 10 mL of water.

GIVING MEDICATION:

Step 1 Wash your hands.

Step 2 Gather the following items:

If possible, give

medications by mouth.



Medication (liquid or tablet)

2 clean syringes: one to check position of the tube and for water flushes, and the other one

for medications Lukewarm tap water in a large cup (use sterile

water if the child is less than 3 months of age)

Utensil or device for crushing pills

Step 3 If the medication is a liquid, go to Step 4. If

medication is not liquid read below before going to

Step 4.

If the medication is a tablet, ask the pharmacist if the medicine can be crushed. If yes, then crush the tablet to a fine powder.

Dissolve the powder in one tablespoon of warm water or as directed by your health care

provider. If the medication cannot be crushed, ask the pharmacist if it comes as a liquid.

For a small infant try to use the least amount of

sterile water – use just enough to dissolve the

powder.

Step 4 Draw up _____ mL of lukewarm water into the syringe for water flushes. Use sterile water if the child is less than 3 months of age.

Step 5 Draw up the right amount of prepared medication into the second syringe.

Step 6 Check the position of the feeding tube by measuring the length. If it is shorter, gently pull on it until it is

the right length. If it is longer, DO NOT USE the tube for feeding. Call the nurse or primary health care doctor.

Step 7 Attach the water-filled syringe to the feeding tube.

Open the feeding tube and flush it with _____ mL. Step 8 Attach the syringe with medication to the feeding tube

and push the medication into the tube.

Liquid

Tablet



Step 9 Draw up _____ mL of water into the water flush syringe and attach it to the feeding tube. Flush the

feeding tube.

Step 10 To give more than one medication, put each medication into a separate syringe and follow Steps 7-9 for each medication.

Step 11 Remove the syringe (and tubing adaptor, if used) and

clamp the feeding tube.

Step 12 Wash the syringes and adaptor in warm, soapy water. Separate the plunger from the barrel of the syringe

to wash. Rinse with hot water and place them on a clean surface to air-dry.

A note about flushes:

The amount of water used for flushes can quickly add up. This is

an important factor with small babies, especially if there are

fluid restrictions. Before you leave the hospital decide with your health care provider the amount of water to use for flushes.

Flushing well before and after

each medication will help to prevent blocking the feeding tube!

Children’s and Women’s Health Centre of BC


Preventing and Solving Problems (Alphabetical Order)

ASPIRATION

Aspiration occurs when stomach contents (formula or water) enters the lungs. It is a very serious problem as it can cause breathing problems and infection.

Signs of aspiration:

Coughing and/or choking while given the feed

A change in breathing pattern to difficult, noisy breathing or rapid shallow breathing

Wet, gurgly voice

Pale or bluish lips

To prevent:

Sit upright or raise the head of the bed 30 to 45

degrees during each feeding and for 30 to 60 minutes after the feeding is finished.

If you think aspiration has occurred:

Stop the feeding right away. Ensure the individual is sitting upright and that the

airway is clear.

For babies, it may be helpful to position them lying on

their side with their head and neck in a neutral position.

If the individual does not improve after taking these

steps, call an ambulance (911) right away.

Prevention

Signs



BLOCKED FEEDING TUBE

A blocked feeding tube can occur when:

The tube is not flushed

Formula is too thick

Residue builds up in the tube

Medications are too thick

To prevent:

Prevention is the key!

Flush Flush Flush Flush tube with warm water before and after feeds and

medications

Crush all medications to a fine powder and dissolve in a small amount of warm water

If the tube blocks:

Use a 30 – 60 mL syringe to gently push 20 mL of warm tap

water through the tube.

For infants less than 3 months of age use sterile water and push up to 10mL of warm sterile water through the tube.

If this does not open the tube, flush with the water and then

pull back on the syringe’s plunger while it is connected to the tube. Repeat this 3 – 4 times.

Prevention

What to Do



If using warm water does not unclog the tube then try

Pancreatic Enzymes to clear:

1. Assemble Equipment

a. Cotazyme Capsule (pancreatic enzyme) b. Sodium Bicarbonate – 1 tablet (325mg) crushed to a fine

powder OR ½ teaspoon of Baking Soda c. Warm Water or Sterile Water for infants less than 3

months of age

d. 60 mL syringe e. small cup

2. WASH hands

3. Draw back as much of the contents of the blocked tube into

the syringe as possible.

4. Place the contents of an opened Cotazyme capsule and a

crushed Sodium Bicarbonate tablet or 2.5 mL (½ tsp) of

Baking Soda into a cup. Add 10 – 15 mL of warm water and

dissolve both medications thoroughly.

5. Draw up the dissolved solution into the 60 mL syringe and

place it into the tube. Clamp off the tube for 15 – 30 minutes.

Milk the tube to get the solution as close as possible to

blocked area.

6. Unclamp the tube and attempt to flush again with warm water

and firm pulling and pushing action. If the tube does not

become clear, repeat above steps, leaving the solution for up

to one hour.

7. If two attempts do not clear the tube then it most likely will

need to be replaced.

If this does not work, contact the nurse or primary health

care doctor for further instructions.



CONSTIPATION

Constipation means that the bowel movements are hard and

difficult to pass and occur less often. Each child has his or her own pattern. Some children have one or more bowel

movements each day. Others have a bowel movement once every few days. Infants and children who are on tube feeds may not have the same pattern as children who eat orally.

To prevent:

Make sure to give the recommended amount of water

flushes.

Encourage daily physical activity.

If constipation occurs:

Ask your health care team contact if :

a different formula or more water or diluted prune

juice may be needed?

any medications might be the cause?

medications might be needed to help?

Contact the nurse, dietitian or primary health care doctor if:

Bowel movements are uncomfortable – they hurt.

Tube feedings are causing bloating, feeling full.

No bowel movement for more than 3 – 4 days.

A small amount of bleeding with bowel movements.

Prevention



DEHYDRATION

Dehydration means that the body does not have enough fluids.

Dehydration can be caused by:

Vomiting Diarrhea

Sweating – this can be due to hot weather and/or fever

Signs of dehydration include:

Dry, sticky tongue

Sunken eyes Cracked, dry lips

Thirst Small amounts of dark yellow urine Fewer wet diapers

Depressed or sunken fontanelle (soft spot on the head) of infants

To prevent:

Make sure that the recommended amounts of formula and water flushes is given each day.

If you think dehydration has occurred:

Babies can become dehydrated very quickly. If you think your baby is dehydrated then contact your health

care provider immediately. Talk with the doctor or nurse before increasing amount of water flushes.

Increase the amount water flushes given before, during

and between feedings. Contact the primary health care doctor or nurse if the

symptoms continue for more than _____ hours.

Signs

Prevention



DIARRHEA

Diarrhea is frequent, watery bowel movements. Check for signs

of dehydration and follow guidelines. See page 38.

To prevent:

Give the formula at the recommended rate.

Make sure all tube-feeding supplies are clean. Wash your hands well before giving the tube feeding.

Make sure the instructions on storing the formula are followed. See page 23.

Do not hang formula for more than the recommended

time. See page 27. Do not use formula that has been in the refrigerator for

more than 24 hours or that has past the expiry date on the container.

Ensure the formula is at room temperature before

giving.

If diarrhea occurs:

Call the nurse or primary health care doctor if there are

more than 5 watery bowel movements in 24 hours. He/She may suggest a temporary change in the tube

feeding for a few days. If the diarrhea is severe – large amounts of loose

stools every 1 to 2 hours, call the primary health care doctor if it continues for longer than:

4 hours in an infant under 3 months of age 8 hours in an infant age 3 – 6 months

1 – 2 days in a child age 7 months to 4 years

Check the child’s temperature to make sure he or she is

not ill. A fever is an oral temperature above 37.4˚C (99.4˚F).

Prevention



continued…

Call the primary health care doctor whenever :

the temperature is 38.5 C (101.3 F) or higher,

or

the temperature is between 37.4 C (99.4 F) and 38.5 C (101.3 F) and the child has had diarrhea for more than 2 days

Keep a daily record of the number of bowel movements and other symptoms and when they occur.

If your child is receiving chemotherapy or is neutropenic and develops a fever, then contact your doctor or

oncologist on call (even if there are no skin signs).

Try a slower feeding rate. If the feedings are not

tolerated at the recommended rate after 48 hours, call

the physician or health care provider.

Ask the health care provider if:

a different formula might help?

any of the medications taken might be causing diarrhea.



FEEDING TUBE FALLS OUT

To prevent:

Follow the instructions on page 10 to help keep the tube in

place. If the tube falls out:

G – Tubes:

Cover the stoma with clean gauze.

If this is a brand new G tube and has been in for less than 6 weeks, go to the nearest hospital emergency

department as soon as possible. The tube needs to be replaced by a health care professional before the stoma shrinks closed.

If the tube has been in for more than 6 weeks, there is a need to replace the tube as soon as possible.

If you have been taught to reinsert the tube, follow the instructions in Appendix E, page 58.

J – Tubes and G-J Tubes:

If this is a G-J tube you need to insert your replacement G tube.

If you have been taught to reinsert the tube, follow the

instructions in Appendix E, page 58.

If your child can tolerate food or medications into their

stomach, then use this tube until you can make an appointment with the radiologist to replace the G-J

tube.

If your child cannot tolerate food or medications through the replacement G tube then you will need to

take your child to the hospital for IV fluid and medications.

Prevention



FLUID AROUND THE TUBE

To prevent:

Make sure the correct flow rate and volume of formula

is given.

Make sure the tube is securely taped to prevent pivoting action or pulling on the stoma. Do not tape low

profile devices. Check for granulation tissue around the tube. Make sure the feeding tube is not blocked – flush with

water frequently.

If leaking occurs: Gastrostomy or JejunostomyTubes (PEG, MIC or J –

tube):

Check to see if the tube is blocked, the stoma is larger or the tube has moved in or out – measure the tube. Call the nurse or primary health care

doctor for advice. If the tube has a balloon internal bumper (MIC

tube or MIC-KEY) and you have been taught to do so, check that the balloon is properly inflated.

Try to keep the area as clean and dry as possible, if necessary, use zinc oxide or gauze to protect the skin around the stoma.

Low Profile Device (Bard Button; MIC-KEY):

Check to see if the tube is blocked, the stoma is

larger or if the tube has moved in or out.

Check once a week to make sure the balloon has

enough water. If your child has a balloon internal bumper type

tube (MIC tube or MIC-KEY), and you have been taught to do so, check that the balloon is

properly inflated with mL of sterile water.

Prevention



FLUID LEAKING THROUGH THE TUBE

Sticky, sugar containing formula or medications can interfere with the one way (anti-reflux) valve. Flush frequently with water through the adaptor.

To prevent in low-profile devices:

Do not leave the adaptor or connector attached

after the feed as it keeps the valve open.

Always use the feeding adaptor. Never put a syringe directly into the feeding tube. The

pressure from the syringe can break the anti-reflux valve.

If leaking occurs:

Bard Button:

The anti-reflux valve in the button may be stuck

open or the valve may be broken. Using the adaptor, flush the tube several times

using warm water to try to unstick the anti-reflux valve.

If this does not work, gently insert a #8 or #10 French Foley catheter or decompression tube into the shaft of the button to see if it can move the

valve back to the closed position. The anti-reflux valve should make a popping sound when closing

and the leaking should stop. Repeat this several times. If this does not stop the leaking, the valve may

be broken and the button will need to be replaced.

Call your nurse or primary health care doctor to help you arrange this.

MIC-KEY:

Using the adaptor, flush with warm water using a 30 mL slip-tip syringe.

If this does not stop the leaking, the device may

need to be replaced. If you have been taught to replace this device, refer to Appendix E, page 58.

If not, call the nurse or primary health care doctor.

Prevention



GRANULATION

“Granulation” tissue or sometimes called proud flesh is a type of

scar tissue that may form around the tube. This red, raised tissue is the body’s reaction to the tube and is very common in some children.

Granulation is a nuisance. It can rub on clothing and bleed easily

and often leaks a sticky yellow fluid. This is not dangerous.

If granulation tissue occurs:

Call the nurse or primary health care doctor to ask about

silver nitrate stick that can help to remove the granulation tissue. When touched by the silver nitrate stick, the granulation tissue turns grey or black, then

becomes crusty and falls off.

Steps for using silver nitrate sticks.

Note: Repeat the following steps once each day for

7 days:

Step 1 Put a layer of Petroleum jelly (Vaseline) on the healthy skin around the piece of red skin before using the silver nitrate stick. Be

careful not to touch normal, healthy skin with the stick as it will injure the healthy skin.

Step 2 Gently touch the silver nitrate onto the piece

of red skin.

Step 3 Protect clothing from being stained by the

silver nitrate (can turn black) by putting a small gauze square over the area and taping it.

If there is no improvement after 7 days, call the

nurse or primary health care doctor.

Treatment



Skin INFECTION Around the Tube or Stoma Site

Signs of skin infection may include:

Skin is fiery red, hot and swollen Discharge from the stoma is thick and cloudy with a white or

yellow-green colour Skin hurts a lot and all the time Fever (temperature above 37.4˚C or 99.4˚F)

Stoma area smells bad

If a skin infection occurs:

Call the primary health care doctor. Soak the skin around the stoma 4 times a day for 5 to 10

minutes each day.

10 Steps for soaking the skin around the stoma:

Step 1 Gather the equipment needed:

3 sterile gauze squares (2 packages) clean bowl

Salt water (see recipe in box) or Normal Saline (sterile salt water).

Step 2 Clean the work surface. Step 3 Wash your hands. Step 4 Pour the warm salt water into the clean bowl.

Step 5 Open the package of gauze and drop into the bowl of salt water.

Step 6 Lift one wet gauze and place over the stoma area. Leave it there for 5 minutes.

Step 7 Repeat Step 5 another 3 times using a new

gauze square each time. Step 8 Let the skin air dry.

Step 9 If the primary health care doctor has ordered an antibiotic cream, put it on now.

Step 10 If there is a lot of leaking around the tube, cut

a gauze square to fit around the tube. Use a small amount of tape to keep the dressing in

place.

Signs

What to do

How to make Salt Water

1. Boil 1 cup of water for 10

minutes. 2. Add ½ teaspoon of salt to

the boiled water and let cool.



Skin IRRITATION Around the Tube or Stoma Site

Signs of skin irritation may include:

The skin is redder than normal and raw looking

There is a watery, thin discharge The skin is tender to touch Skin irritation may be caused by leakage around the

tube.

To prevent:

Make sure that the tube is stable so that it does not move around

Gently pull on the tube to ensure that the balloon/end

of the tube is up against the stomach wall. If you have been taught to do so, check the amount of water in the

balloon.

If a skin irritation occurs:

Keep the area clean. Wash with mild soap and warm

water 3 – 4 times each day and pat dry.

Expose the skin to air for about 30 minutes at least 3 times a day.

Ensure the tube is secure with tape and there is no

pivoting action of the G-tube. If there is a lot of leaking around the tube, cut a gauze

square to fit around the tube. Use a small amount of tape to keep the dressing in place.

Call the nurse or primary health care doctor if this does

not clear up within 3 days. Use of a cream may be suggested.

Prevention

Signs



STOMACH FULLNESS/BLOATING

Stomach fullness and bloating may be caused by:

Feeding is given too quickly

Swallowing air

Signs of stomach fullness/bloating may include:

The child may have pain or discomfort in the abdomen or be restless and cry.

A child who is unable to communicate may vomit or burp. Please note:

Sometimes a bloated, full feeling may indicate

constipation. See page 37 for tips on constipation.

To prevent:

Follow the feeding guidelines for the type of formula, rate

and schedule

If fullness or bloating occur:

Decrease the feeding rate.

Stop the feeding for 1 – 2 hours and then restart the feeding at a slower rate. Slowly increase the rate to the

highest rate that is comfortable. If the usual rate cannot be reached, call the health care provider.

Try to decompress the stomach before feeding. Attach the outside only (barrel) of a 30 mL syringe to the end of

the feeding tube or, for the low profile devices, attach it to the adaptor. Hold the syringe barrel above the stomach to allow gas to escape for about 5 to 20 minutes. If

stomach juices come into the syringe, allow the juices to flow back, by gravity, into the stomach to prevent the loss

of electrolytes.

Signs

Prevention



VOMITING

Vomiting or gagging may be caused by:

Stomach is too full Feeding is given too quickly Illness

To prevent further vomiting:

Start feeding slowly. If your child tolerates the feed,

slowly increase the rate to desired rate.

Position the child in a sitting position in a chair or in a wheelchair or with the head of the bed elevated.

Allow a quiet time after feeds.

Vent the tube or burp the child before, during and/or after the feeding. Try to decompress the stomach before feeding.

Attach the outside only (barrel) of a 30 mL

syringe to the end of the feeding tube or, for the low profile devices, attach it to the

adaptor. Hold the syringe barrel above the stomach to

allow gas to escape for about 5 to 20 minutes.

If stomach juices come into the syringe, allow the juices to flow back, by gravity, into the

stomach to prevent the loss of electrolytes.

When flushing the tube, do it slowly.

If vomiting occurs during a feed, stop the feed. If the

child is lying down, turn the head to the side or have them sit up.

If the vomiting continues and the child seems ill or has

a fever, call the nurse or primary health care doctor.

Prevention



Who to Contact with your Questions & Concerns

Questions Or Concerns About Contact

Weight: Dietitian

Nurse Primary health care doctor

Tube feeding supplies: Nurse

Dietitian Community Liaison Nurse (AHP)

Formula: Dietitian

Primary health care doctor

Feeding tube or feeding tube site care: Nurse

Skin problems: Nurse


Tube Feeding at School or Daycare: Nursing Support Services

Feeding pump: Pump rental store or company

At Home Program

Oral stimulation during tube feeding: Occupational Therapist

Speech-Language Pathologist

Oral Feeding: Dietitian Occupational Therapist

Speech-Language Pathologist Primary health care doctor

Nurse Feeding Team



Telephone Numbers

Contact Name Phone Number

Dietitian

Nurse

Nursing Support

Services


Occupational Therapist

Speech-Language Pathologist (SLP)

Nurse Clinician

Distribution Center

(AHP/HEN)

Other:



Appendices



Appendix A: Monitoring Progress

Date Weight Feeding Schedule Concerns/Questions What to Do?



Date Weight Feeding Schedule Concerns/Questions What to Do?



“How to make the best use of clinic

visits or appointments with your

child’s health care team.”

Appendix B: Ongoing Questions & Concerns

You will have more questions and concerns come up over time.

Here are some tips on how to make sure that you have them

answered.

At home:

Keep a journal of your questions and concerns.

If you want to talk with a certain person at the clinic or

office, call ahead to make a set time.

Ask a family member or friend to come with you to take notes,

offer support, or help care for your child while you talk to the

health care team.

At the clinic or appointment:

Ask your most important questions early in the appointment

Take notes to help you remember what was said.

Let the team know as much as you can about your thoughts on

your child’s health and how your child is doing with the tube

feeding – you know your child best!

If you do not understand the medical words used – ask.

Sometimes a picture can help you to understand what is being

said – ask for one.

Repeat what you think was said to you.



Appendix C: List of Terms

Abdomen contains the stomach, small and large intestines, liver,

gall bladder, spleen, pancreas, and bladder

Aspiration occurs when fluid enters the lungs

Abscess a localized collection of pus in a tissue or body part

resulting from the invasion of bacteria

Decompression tube a device which allows air/fluid to escape (venting)

from the stomach via a gastrostomy tube

Gastric decompression release of air trapped in the stomach

Gastric outlet

obstruction

blockage at the end of the stomach

Gastric tube

(gastrostomy tube, G-tube)

a feeding tube that supplies food directly into the

stomach through a permanent surgical opening (gastrostomy) made into the stomach

Gastro-jejunal tube (GJ

tube)

a feeding tube that passes through the stomach via

the gastrostomy into the jejunum.

Granulation tissue

(proud flesh)

naturally occurring scar tissue that forms around the

tube

Gavage feeding by a tube passed into the stomach

Ileus An intestinal obstruction or blockage

Jejunal tube ( j-tube) a feeding tube that supplies food directly into the small intestine through a surgical opening

(jejunostomy) made into small intestine

Jejunum the second portion of the small intestine (small bowel)

Laparascopy surgical procedure that explores the abdomen using a type of camera called a laparascope



Laparotomy the surgical opening of the abdomen

Nissan fundoplication An operation that is used in the treatment of stomach

acid reflux into the esophagus

Peristomal skin area around the stoma

Pyloroplasty this is an operation where the pylorus muscle is partially divided allowing the food to move more easily from the stomach to the small intestine

Reflux backward flowing of a substance (e.g. return of fluids to the mouth from the stomach)

Roux en y surgical procedure that takes a portion of the jejunum and creates a limb that forms the stoma for the jejunostomy tube

Stoma an artificial opening



Appendix D: Additional Resources for Families &

Caregivers

Books

Videos

Websites



Appendix E: Reinserting a Gastrostomy Tube (G-Tube) GENERAL INFORMATION:

The PEG tube or Bard button low profile device cannot be reinserted. Instead,

use the Foley catheter given to you by the hospital.

Foley catheter, MIC tube or MIC-KEY can be reinserted as follows:

Check the balloon for leaks by inflating the balloon with 5 mL of sterile water. If no leaks,

deflate the balloon and proceed to inserting the tube as

described below.

If there are leaks, throw away

the tube and check the balloon on a new tube.

If there are no leaks, remove

the 5mL of water from the

balloon and insert the tube as described below.

Figure 10: Foley Gastronomy Tube

REINSERTION:

Step 1 Wash hands well and gather the following equipment:

feeding tube or Foley catheter tape



5 mL syringe – to inflate the balloon 5 mL water – to inflate the balloon

measuring tape (if a balloon-type catheter is used) water-soluble lubricant

tape measure

Step 2 Draw up 5 mL of water into the syringe.

Step 3 Check the balloon on the new feeding tube before putting it into the

stoma by inflating it with the water.

Step 4 Deflate the balloon by pulling the water back into the syringe.

Step 5 Moisten the end of the tube with water or a water-soluble lubricant (for example, K-Y jelly) as it makes the tube go in easier.

Step 6 Insert the new tube about 2 inches into the stoma.

Step 7 Inflate the balloon with the 5 mL of water in the syringe. Remove the empty syringe from the tube.

Step 8 Gently pull on the tube so it is snug against the stomach wall.

Step 9 If a catheter is used, measure the length of the catheter from the stoma to the end and record the length. Put a mark on the tube where it comes out of the body.

Step 10 Clean and dry the skin. Tape the tube to the skin to secure.

Step 11 Check the placement of the tube by withdrawing stomach contents; allow the contents to flow back into the stomach.

Step 12 If unable to withdraw stomach contents, reposition the person and try

again. If no stomach contents, wait ½ hour and try again. If you are not sure that tube is in the stomach, do not use. Call the nurse or primary

health care doctor.



Appendix F: Reinserting a Jejunostomy Tube (J-Tube)


If using a Foley catheter as a jejunostomy tube, DO NOT inflate the balloon on

the catheter as it may block the small bowel causing an obstruction.

Never force the tube. If it is difficult to insert, stop and go to the nearest

hospital since repeated tries with force may put a hole in the small bowel.

REINSERTION:

Step 1 Wash hands well and gather the following equipment:

feeding tube

tape measuring tape water-soluble lubricant

Step 2 Moisten the end of the tube with water-soluble lubricant (for example, K-Y jelly) as it makes the tube go in easier.

Step 3 Insert the new tube about 2 inches into the stoma or as per instructed. Tape the tube securely to the stomach.

Step 4 Measure the length of the catheter from the stoma to the end and record the length. Put a mark on the tube where it comes out of the body.

Step 5 Phone your nurse of primary care doctor to help make arrangements to have the tube replaced.



References

1. Alberta Home Nutrition Support Services (2000). Nasogastric Tube Feeding Your

Child: A Resource Booklet for Families. Capital Health Region.

2. Anderton, A. & Nwoguh, CE. (1991). Re-use of enteral feeding tubes-a potential

hazard to the patient? A study of the efficiency of a representative range of cleaning

and disinfecting procedures. Journal of Hospital Infection, 18, 131 – 138.

3. Anderton, A. & Aidoo, KE. (1990) The effect of handling procedures on microbial

contamination of enteral feeds: A comparison of the use of sterile vs non-sterile

gloves. Journal of Hospital Infection, 17 (4): 297-301.

4. Aneiros, S & Rollins, H. (1996). Home enteral tube feeding. Community Nurse. 28-

33.

5. BC Women’s and Children’s Hospital (1998). Gavage/Enteral Feeding (Nasogastric,

Gastrostomy and Jejunal Tube Feedings) for Children and Infants. Nursing Policy

and Procedure Manual. Policy: NG001.

6. Brooks, L (2002) Clearing Occluded Feeding Tubes: Moving from Ginger Ale to

Enzymes (or taking the “Coazyme Challenge”) Practice – Dietitions of Canada Issue

#20:8

7. Campbell, SM. (1995). Preventing Microbial Contamination of Enteral Formulas and

Delivery Systems, Ross Medical Nutrition Systems.

8. Children’s Hospital of Eastern Ontario. (1998). Home Enteral Feeding Programme:

General Guidelines.

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Sincere thanks to the many contributors and

reviewers who gave so generously of their time.

The following groups were involved in completing this project:

C&W Nutrition Committee Feeding Team at Sunny Hill

Gastroenterology Nursing Support Services

Nutrition and Food Services Occupational Therapy

Pediatric Surgery

Special Care Nursery

Information Compiled by:

Linda Yearwood, RN, MSN

Financial Assistance Gratefully Provided by:

Sunny Hill Health Centre for Children Auxiliary

tube feeding at home: a guide for families and … · feeding at home. please know that we will...

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